摘要：

目的 在保護(hù)動(dòng)機(jī)理論指導(dǎo)下，構(gòu)建妊娠期糖尿?。╣estational diabetes mellitus，GDM）孕婦血糖管理決策行為模型。 方法 采用便利抽樣法，于2019年9月—2020年7月選取上海市和江蘇省6所醫(yī)院的1 261例GDM孕婦作為調(diào)查對(duì)象，采用GDM血糖管理決策行為問卷、保護(hù)動(dòng)機(jī)問卷、知識(shí)問卷及一般資料調(diào)查表進(jìn)行調(diào)查，采用多元線性回歸分析決策行為的影響因素，依據(jù)多因素分析結(jié)果構(gòu)建決策行為初始模型，并采用結(jié)構(gòu)方程模型對(duì)模型進(jìn)行修正和優(yōu)化。 結(jié)果 該調(diào)查共收回有效問卷1 181份。保護(hù)動(dòng)機(jī)中的易感性、嚴(yán)重性、反應(yīng)效能、自我效能、反應(yīng)代價(jià)是GDM孕婦血糖管理決策行為的影響因素（P<0.001）。結(jié)構(gòu)方程模型結(jié)果顯示，GDM孕婦在血糖管理中對(duì)嚴(yán)重性（β=0.204）、易感性（β=0.196）的感知及自我效能（β=0.336）對(duì)其決策行為產(chǎn)生直接正向影響，同時(shí)易感性也通過自我效能對(duì)決策行為產(chǎn)生間接正向影響（β=0.136）；反應(yīng)代價(jià)對(duì)決策行為產(chǎn)生直接負(fù)向影響（β=-0.186），血糖管理知識(shí)通過影響反應(yīng)代價(jià)對(duì)決策行為產(chǎn)生間接影響（β=0.016）。模型適配度檢驗(yàn)指標(biāo)均達(dá)到可接受的標(biāo)準(zhǔn)，各路徑系數(shù)均達(dá)到顯著水平（P<0.05）。 結(jié)論 產(chǎn)科護(hù)理人員可通過強(qiáng)化GDM孕婦對(duì)血糖管理不佳的易感性和嚴(yán)重性的感知，提高其血糖管理信心，并提供血糖管理的相關(guān)知識(shí)，以減少對(duì)血糖管理障礙的感知，促進(jìn)GDM孕婦積極的血糖管理決策行為。

關(guān)鍵詞: 妊娠期糖尿病, 血糖管理, 決策行為, 模式構(gòu)建, 保護(hù)動(dòng)機(jī)理論, 產(chǎn)科護(hù)理

Abstract:

Objective To construct the decision-making behavior model of blood glucose management among pregnant women with gestational diabetes mellitus（GDM） based on protection motivation theory. Methods A total of 1 261 pregnant women with GDM from 6 hospitals in Shanghai and Jiangsu province were selected by convenient sampling and investigated through the cross-sectional survey. The Self-Developed Blood Glucose Management Decision-Making Behavior Questionnaire，Protection Motivation Questionnaire，Knowledge Questionnaire and General Information Questionnaire were used to collect data. Multi-linear regression analysis was used to identify the influencing factors of decision-making behavior. Structural equation model was used to establish and revise the decision-making behavior model of blood glucose management. Results 1 181 pregnant women with GDM were included in this study. Vulnerability，severity，response efficacy，self-efficacy and response costs were influencing factors of blood glucose management decision-making behavior（P<0.001）. Perceived severity（β=0.204），vulnerability （β=0.196） and self-efficacy（β=0.336） had a direct positive influence on decision-making behavior. Perceived vulnerability had an indirect positive influence on decision-making behavior mediated by self-efficacy（β=0.136）. Response costs（β=-0.186） had a direct negative influence on decision-making behavior. Knowledge had an indirect influence on decision-making behavior mediated by response costs（β=0.016）. All the indicators for fit test were acceptable or optimal，and the path coefficients of model reached significant level（P<0.05）. Conclusion The decision-making behavior of blood glucose management among pregnant women with GDM could be improved through increasing perceived severity，vulnerability and confidence，providing more knowledge and decreasing barriers related to blood glucose management.

Key words: Gestational Diabetes Mellitus, Blood Glucose Management, Decision-Making Behavior, Model Construction, Protection Motivation Theory, Obstetric Nursing

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